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General NPI Number Information
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NPI Number | 1366235780
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Entity Type | Individual
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Provider Name | MASEY LODGE STUBBLEFIELD ED.S
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Gender | Female
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Dates
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Enumeration Date | 05/28/2025
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Last Update Date | 05/28/2025
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Provider Practice Location Address
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Address Line | 522 HAMILTON AVE
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City | CHATTANOOGA
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State | TN
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Zip | 37405-3937
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Country | US
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Telephone | 423-280-7761
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Fax |
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Provider Business Mailing Address
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Address Line | 522 HAMILTON AVE
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City | CHATTANOOGA
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State | TN
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Zip | 37405-3937
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Country | US
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Telephone | 423-280-7761
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 000601749
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License Number State | TN
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